DOMS: What It Is and How to Reduce It

Almost everyone who has started training or changed their program knows the feeling: the next morning the stairs turn into an ordeal, and a day later it gets even worse. This is delayed onset muscle soreness (DOMS). There are many myths around it — from “lactic acid” to the belief that there is no growth without pain. The editorial team explains what actually happens in the muscles and which methods have an evidence base.

What DOMS is

DOMS is the pain, stiffness and tenderness of muscles that appears not during the load but a few hours after it. Usually the unpleasant sensations build over the first day, peak at 24–72 hours and gradually fade over 5–7 days. That is precisely why the English-language literature uses the term DOMS — delayed onset muscle soreness.

DOMS most often occurs after unaccustomed load: at the start of training, after a break, when changing exercises, increasing volume or working in a new range of motion. Classic examples are the first squats after a vacation, downhill running, “negative” repetitions with heavy weight.

Besides pain, DOMS is accompanied by a temporary reduction in strength and range of motion, muscle swelling and a rise in blood creatine kinase. The review by Cheung, Hume and Maxwell (2003) notes that the loss of strength can last longer than the pain itself, and this is important to consider when planning subsequent workouts.

The sensations are usually symmetrical and diffuse: the whole muscle or a large part of it hurts, especially closer to where it transitions into the tendon. The pain intensifies with pressure, stretching and contraction of the muscle, but at rest it is felt more weakly.

Why the pain occurs: mechanisms

The main “culprit” of DOMS is eccentric work, that is, contraction of a muscle while it lengthens. This happens when we lower a weight, decelerate, run downhill. Proske and Morgan (2001) described that during such work individual sarcomeres are overstretched and micro-damage to the structure of the muscle fibers occurs.

The micro-damage itself does not hurt. The pain appears later, when an inflammatory reaction unfolds: immune cells migrate into the muscle and mediators are released that raise the sensitivity of pain receptors. Modern research also draws attention to the connective tissue around the fibers (the fascia), which can be a significant source of pain.

A very important phenomenon is the repeated bout effect. After a single episode of eccentric work the muscle adapts, and a repeat of the same training a few days or weeks later causes considerably less pain and damage. Hyldahl, Chen and Nosaka (2017) explain this by a combination of neural, mechanical and cellular changes.

It is precisely because of the repeated bout effect that experienced athletes who train regularly feel DOMS rarely and weakly — even though their loads are far greater than those of beginners. Strong pain in a trained person usually indicates a sharp change in the program.

Myths about DOMS

Myth 1: DOMS is caused by lactic acid.Lactate forms during intense work, but it is cleared from the muscles and blood within about an hour after the load. At the moment DOMS peaks, a day or two later, elevated lactate is long gone. Moreover, concentric exercises produce a lot of lactate but little DOMS.

Myth 2: no pain, no gain.Schoenfeld and Contreras (2013) analyzed this question and concluded that DOMS is not a reliable indicator of training effectiveness. Hypertrophy and strength can grow even without noticeable pain, while strong DOMS often merely indicates the unfamiliarity of the load.

Myth 3: stretching before or after training prevents DOMS.The Cochrane review by Herbert and co-authors showed that static stretching has practically no effect on delayed soreness. Stretching is useful for mobility, but not as a remedy against DOMS.

Myth 4: you cannot train with DOMS.Light activity does no harm and even temporarily reduces the pain. However, a hard workout of the same muscle at the peak of DOMS will be lower in quality because of reduced strength, so it is wiser to load other groups or work more lightly.

What helps to reduce the pain

The most effective prevention is gradual progression. It is better to introduce new exercises, increase volume and the eccentric component gradually, over several weeks. The first workout after a break should be deliberately light: the repeated bout effect will protect against strong pain in the following ones.

As for recovery aids, the meta-analysis by Dupuy and co-authors (2018) compared various techniques and found that massage had the most pronounced effect on reducing DOMS and fatigue. Compression garments and cold-water immersion also showed some benefit, whereas the effects of active recovery and stretching were negligible.

As for cold water there is an important nuance: the Cochrane review by Bleakley and co-authors (2012) confirmed a small reduction in pain, but individual studies show that regular cooling after strength training may weaken long-term adaptations. So it is more appropriate to reserve it for the competitive period, when fast recovery matters.

Among nutritional approaches, there is some data for adequate intake of protein, caffeine and certain polyphenols (in particular cherry concentrate), but the effects are moderate and inconsistent. No supplement “cancels” DOMS, and the foundation remains sleep and full nutrition.

When the pain is not DOMS

DOMS is symmetrical, diffuse and gradually fades. Sharp local pain that arises suddenly during an exercise, often with a sensation of a “pop” or “blow”, is more characteristic of a muscle strain or tear. In that case training must be stopped and a doctor consulted.

A dangerous condition that is important to distinguish from ordinary DOMS is rhabdomyolysis. This is massive destruction of muscle cells, when the muscle contents, in particular myoglobin, enter the blood and can damage the kidneys. It occurs after extreme loads, especially in untrained people, in the heat, against a background of dehydration, alcohol or certain medications.

• tea- or cola-colored urine;
• severe pain and pronounced muscle swelling that does not decrease but grows;
• weakness, nausea, reduced amount of urine.

With any of these signs, emergency medical care is needed: rhabdomyolysis is diagnosed with a creatine kinase test and treated in hospital. “Walking off” such a condition on your own is unacceptable.

You should also see a doctor if the pain does not pass for more than a week, is accompanied by a fever, reddening of the skin, or limits movement in a joint.

Editorial conclusions

DOMS is a normal reaction of muscles to unaccustomed, above all eccentric, load. It is linked to micro-damage and inflammation, not to lactic acid.

Pain is not a measure of a workout's effectiveness. Thanks to the repeated bout effect, regular training noticeably reduces DOMS without loss of progress.

The best prevention is gradual progression, and among relief measures the strongest data belong to massage. Stretching does practically nothing for DOMS.

We also recommend reading our materials on the signs of insufficient recovery, on recovery after a marathon and after a powerlifting competition.

References

1. Cheung K, Hume P, Maxwell L. Delayed onset muscle soreness: treatment strategies and performance factors. Sports Med. 2003;33(2):145–164.
2. Proske U, Morgan DL. Muscle damage from eccentric exercise: mechanism, mechanical signs, adaptation and clinical applications. J Physiol. 2001;537(Pt 2):333–345.
3. Hyldahl RD, Chen TC, Nosaka K. Mechanisms and mediators of the skeletal muscle repeated bout effect. Exerc Sport Sci Rev. 2017;45(1):24–33.
4. Dupuy O, Douzi W, Theurot D, et al. An evidence-based approach for choosing post-exercise recovery techniques to reduce markers of muscle damage, soreness, fatigue, and inflammation: a systematic review with meta-analysis. Front Physiol. 2018;9:403.
5. Schoenfeld BJ, Contreras B. Is postexercise muscle soreness a valid indicator of muscular adaptations? Strength Cond J. 2013;35(5):16–21.
6. Bleakley C, McDonough S, Gardner E, et al. Cold-water immersion (cryotherapy) for preventing and treating muscle soreness after exercise. Cochrane Database Syst Rev. 2012;(2):CD008262.
7. Herbert RD, de Noronha M, Kamper SJ. Stretching to prevent or reduce muscle soreness after exercise. Cochrane Database Syst Rev. 2011;(7):CD004577.